Provider Demographics
NPI:1285686154
Name:JANA, KYU KIM (MD)
Entity Type:Individual
Prefix:
First Name:KYU
Middle Name:KIM
Last Name:JANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KYU WON
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1250
Mailing Address - Country:US
Mailing Address - Phone:409-744-4030
Mailing Address - Fax:409-740-4187
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1250
Practice Address - Country:US
Practice Address - Phone:409-744-4030
Practice Address - Fax:409-740-4187
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227412207Q00000X
FLME99852207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026166201OtherUNIVERA #
NY040426003337OtherFIDELIS CARE #
NY5996171OtherGHI PPO #
NYP00189134OtherMEDICARE RAILROAD #
NY0492681OtherIHA #
NY159651BFOtherPREFERRED CARE #
NY000527217002OtherHEALTH NOW BCBS #
NY00026166201OtherUNIVERA #
NY000527217002OtherHEALTH NOW BCBS #